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1. C. The nurse is responsible and accountable for correct delegation. This includes the right task delegated to the right person with adequate communication about specific expectations for performance. The nurse’s assessment of the client’s condition and ability to ambulate would guide what information would be conveyed to the nursing assistant.
2. C. The responsibility for the delivery of quality care rests with the person who directly provides the care. Nurses have a great impact on the quality of care provided in any healthcare organization
3. A. The durable power if attorney for health care designates someone to make decisions. This includes refusing of removing treatment.
4. B. Nonmaleficence refers to the requirement to do no harm and to protect clients from harm if they cannot protect themselves. The actions taken in this situation are important for the prevention of inquiries due to falling.
5. D. Long term commitment to lifestyle changes is based in intrinsic motivation. The individual must choose to take the actions necessary for health changes.
6. C. A client with ongoing needs for care or rehabilitation is very likely to receive care that is directly by a case manager due to the complexity and cost of the client’s needs.
7. D. This situation represents a variation form the standard of care and will cause a change in the plan of care for this client due to the need to delay the surgical procedure.
8. D. Nurses are often the best members of the healthcare team to address this issue with clients and families due to the relationship that has developed in the care process.
9. C. This statement presents some of the facts and assessments related to this event. The nurse would also include vital signs further assessment, notification of physician, treatment or procedures done per physician orders, and client’s response.
10. B. Nurses focus on outcome and the client’s “journey” through services and settings when addressing continuity of care.
11. C. The HMO establishes the specific services that are covered at a fixed level of reimbursement to the provider and cost to the participant.
12. B. Having a Bible available for scripture reading is important to members of this faith.
13. C. Clarification is a communication process that strives to ensure that the nurse and client understand the same meaning for events and processes.
14. C. A person who feels comfortable talking about organ donation is best suited for this task. If the nurse of physician is uncomfortable with the topic, this feeling could be transferred to the family and influence their decision. Knowledge about the process of donation is also important so the family’s questions can be answered.
15. A. An essential attribute of the nurse acting in the advocate role is being open-minded. The focus is on supporting the client’s decisions regardless of the nurse’s personal beliefs about what the decision should be. Client self-determination is the priority.
16. C. As a Jehovah’s Witness, this client will believe that blood transfusion violates God’s laws and will not be likely to consent to a transfusion if needed.
17. A. The most important factor in the successful maintenance of continuity of care is to have a plan that includes all disciplines and agencies that are appropriate to this client’s care and that are needed to achieve desired outcomes.
18. C. Send a note of thanks. Include comments about continued interest in the position and any other information that needs to be reinforced of relayed to the nurse manager.
19. D. As an advocate, nurses interpret information for clients and their families so that they can make informed decisions. This is a good example of a nursing action that is based in the advocate role
20. C. Because there are genetic commonalties within races, it is more likely that a better match will be found. The closeness of the match between donor and recipient impacts the success of the transplant and minimizes the risk of rejection.
21. C. This tone to the nurse’s questions will give offer the best chance of keeping communication open with the client and getting the information needed to make an accurate assessment of this client’s situation
22. C. Computers do present different challenges to maintaining confidentiality. These include access control using passwords and restricted access, limited screen time, and secure locations for computer terminals.
23. B. The law protects nurses and other mandatory reports from any civil or criminal action related to reporting of suspected cases of abuse. This is to remove this barrier to reporting.
24. D. Client independence is the ultimate goal in public health nursing. Interventions are planned that support this goal.
25. C. This nurse is demonstrating expert power that is based on expertise in critical-care nursing practice.